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Mansouri H, Kemerli M, MacIver R, Amili O. Development of idealized human aortic models for in vitro and in silico hemodynamic studies. Front Cardiovasc Med 2024; 11:1358601. [PMID: 39161662 PMCID: PMC11330894 DOI: 10.3389/fcvm.2024.1358601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/25/2024] [Indexed: 08/21/2024] Open
Abstract
Background The aorta, a central component of the cardiovascular system, plays a pivotal role in ensuring blood circulation. Despite its importance, there is a notable lack of idealized models for experimental and computational studies. Objective This study aims to develop computer-aided design (CAD) models for the idealized human aorta, intended for studying hemodynamics or solid mechanics in both in vitro and in silico settings. Methods Various parameters were extracted from comprehensive literature sources to evaluate major anatomical characteristics of the aorta in healthy adults, including variations in aortic arch branches and corresponding dimensions. The idealized models were generated based on averages weighted by the cohort size of each study for several morphological parameters collected and compiled from image-based or cadaveric studies, as well as data from four recruited subjects. The models were used for hemodynamics assessment using particle image velocimetry (PIV) measurements and computational fluid dynamics (CFD) simulations. Results Two CAD models for the idealized human aorta were developed, focusing on the healthy population. The CFD simulations, which align closely with the PIV measurements, capture the main global flow features and wall shear stress patterns observed in patient-specific cases, demonstrating the capabilities of the designed models. Conclusions The collected statistical data on the aorta and the two idealized aorta models, covering prevalent arch variants known as Normal and Bovine types, are shown to be useful for examining the hemodynamics of the aorta. They also hold promise for applications in designing medical devices where anatomical statistics are needed.
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Affiliation(s)
- Hamid Mansouri
- Department of Mechanical, Industrial, and Manufacturing Engineering, University of Toledo, Toledo, OH, United States
| | - Muaz Kemerli
- Department of Mechanical, Industrial, and Manufacturing Engineering, University of Toledo, Toledo, OH, United States
- Department of Mechanical Engineering, Sakarya University, Sakarya, Turkey
| | - Robroy MacIver
- Children’s Heart Clinic, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, United States
| | - Omid Amili
- Department of Mechanical, Industrial, and Manufacturing Engineering, University of Toledo, Toledo, OH, United States
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de Turenne A, Eugène F, Blanc R, Szewczyk J, Haigron P. Catheter navigation support for mechanical thrombectomy guidance: 3D/2D multimodal catheter-based registration with no contrast dye fluoroscopy. Int J Comput Assist Radiol Surg 2024; 19:459-468. [PMID: 37964153 DOI: 10.1007/s11548-023-03034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE The fusion of pre-operative imaging and intra-operative fluoroscopy may support physicians during mechanical thrombectomy for catheter navigation from the aortic arch to carotids. Nevertheless, the aortic arch volume is too important for intra-operative contrast dye injection leading to a lack of common anatomical structure of interest that results in a challenging 3D/2D registration. The objective of this work is to propose a registration method between pre-operative 3D image and no contrast dye intra-operative fluoroscopy. METHODS The registration method exploits successive 2D fluoroscopic images of the catheter navigating in the aortic arch. The similarity measure is defined as the normalized cross-correlation between a binary combination of catheter images and a pseudo-DRR resulting from the 2D binary projection of the pre-operative 3D image (MRA or CTA). The 3D/2D transformation is decomposed in out-plane and in-plane transformations to reduce computational complexity. The 3D/2D transformation is then obtained by maximizing the similarity measure through multiresolution exhaustive search. RESULTS We evaluated the registration performance through dice score and mean landmark error. We evaluated the influence of parameters setting, aortic arch type and 2D navigation sequence duration. Results on a physical phantom and data from a patient who underwent a mechanical thrombectomy showed good registration accuracy with a dice score higher than 92% and a mean landmark error lower than the quarter of a carotid diameter (8-10 mm). CONCLUSION A new registration method compatible with no contrast dye fluoroscopy has been proposed to guide the crossing from aortic arch to a carotid in mechanical thrombectomy. First evaluation showed the feasibility and accuracy of the method as well as its compatibility with clinical routine practice.
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Affiliation(s)
| | - François Eugène
- CHU Rennes, Inserm, LTSI - UMR 1099, Univ Rennes, Rennes, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, 75019, Paris, France
| | - Jérôme Szewczyk
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 75005, Paris, France
| | - Pascal Haigron
- CHU Rennes, Inserm, LTSI - UMR 1099, Univ Rennes, Rennes, France
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Katsarou M, Mandigers TJ, Berczeli M, Mujeeb Zubair M, Belvroy VM, Bissacco D, van Herwaarden JA, Trimarchi S, Bismuth J. Sex-Specific Morphometric Analysis of Ascending Aorta and Aortic Arch for Planning Thoracic Endovascular Aortic Repair: A Retrospective Cohort Study. J Endovasc Ther 2023:15266028231210228. [PMID: 37936418 DOI: 10.1177/15266028231210228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
OBJECTIVE In many studies on aortic disease, women are underrepresented. The present study aims to assess sex-specific morphometric differences and gain more insight into endovascular treatment of the ascending aorta (AA) and arch. METHODS Electrocardiogram-gated cardiac computed tomography scans of 116 consecutive patients who were evaluated for transcatheter aortic valve replacement were retrospectively reviewed. Measurements of the AA and aortic arch were made in multiplanar views, perpendicular to the semi-automatic centerline. Multiple linear regression analysis was performed to identify predictors affecting AA and aortic arch diameter in men and women. Propensity score matching was used to investigate whether sex influences aortic morphology. RESULTS In both sexes, body surface area (BSA) was identified as a positive predictor and diabetes as a negative predictor for aortic diameters. In men, age was identified as a positive predictor and smoking as a negative predictor for aortic diameters. Propensity score matching identified 40 pairs. Systolic and diastolic mean diameters and AA length were significantly wider in men. On average, male aortas were 7.4% wider than female aortas, both in systole and diastole. CONCLUSIONS The present analysis demonstrates that, in women, increased BSA is associated with increased aortic arch diameters, while diabetes is associated with decreased AA and arch diameters. In men, increased BSA and age are associated with increased AA and arch diameters, while smoking and diabetes are associated with decreased AA and arch diameters. Men were confirmed to have 7.4% greater AA and arch diameters than women. CLINICAL IMPACT Men had 7.4% greater ascending aorta and arch diameters than women in a retrospective cohort, gated computed tomography-based study of 116 patients. Sex-specific differences in ascending aortic and arch size should be considered by aortic endovascular device manufacturers and physicians when developing ascending and arch endografts and planning aortic interventions.
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Affiliation(s)
- Maria Katsarou
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Milan, Italy
| | - Tim J Mandigers
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Milan, Italy
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marton Berczeli
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Department of Vascular Surgery, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - M Mujeeb Zubair
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Viony M Belvroy
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Daniele Bissacco
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Santi Trimarchi
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Jean Bismuth
- Division of Vascular Surgery, LSU School of Medicine, New Orleans, LA, USA
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Geronzi L, Haigron P, Martinez A, Yan K, Rochette M, Bel-Brunon A, Porterie J, Lin S, Marin-Castrillon DM, Lalande A, Bouchot O, Daniel M, Escrig P, Tomasi J, Valentini PP, Biancolini ME. Assessment of shape-based features ability to predict the ascending aortic aneurysm growth. Front Physiol 2023; 14:1125931. [PMID: 36950300 PMCID: PMC10025384 DOI: 10.3389/fphys.2023.1125931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
The current guidelines for the ascending aortic aneurysm (AsAA) treatment recommend surgery mainly according to the maximum diameter assessment. This criterion has already proven to be often inefficient in identifying patients at high risk of aneurysm growth and rupture. In this study, we propose a method to compute a set of local shape features that, in addition to the maximum diameter D, are intended to improve the classification performances for the ascending aortic aneurysm growth risk assessment. Apart from D, these are the ratio DCR between D and the length of the ascending aorta centerline, the ratio EILR between the length of the external and the internal lines and the tortuosity T. 50 patients with two 3D acquisitions at least 6 months apart were segmented and the growth rate (GR) with the shape features related to the first exam computed. The correlation between them has been investigated. After, the dataset was divided into two classes according to the growth rate value. We used six different classifiers with input data exclusively from the first exam to predict the class to which each patient belonged. A first classification was performed using only D and a second with all the shape features together. The performances have been evaluated by computing accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUROC) and positive (negative) likelihood ratio LHR+ (LHR-). A positive correlation was observed between growth rate and DCR (r = 0.511, p = 1.3e-4) and between GR and EILR (r = 0.472, p = 2.7e-4). Overall, the classifiers based on the four metrics outperformed the same ones based only on D. Among the diameter-based classifiers, k-nearest neighbours (KNN) reported the best accuracy (86%), sensitivity (55.6%), AUROC (0.74), LHR+ (7.62) and LHR- (0.48). Concerning the classifiers based on the four shape features, we obtained the best accuracy (94%), sensitivity (66.7%), specificity (100%), AUROC (0.94), LHR+ (+∞) and LHR- (0.33) with support vector machine (SVM). This demonstrates how automatic shape features detection combined with risk classification criteria could be crucial in planning the follow-up of patients with ascending aortic aneurysm and in predicting the possible dangerous progression of the disease.
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Affiliation(s)
- Leonardo Geronzi
- Department of Enterprise Engineering “Mario Lucertini”, University of Rome Tor Vergata, Rome, Italy
- Ansys France, Villeurbanne, France
- *Correspondence: Leonardo Geronzi,
| | - Pascal Haigron
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Antonio Martinez
- Department of Enterprise Engineering “Mario Lucertini”, University of Rome Tor Vergata, Rome, Italy
- Ansys France, Villeurbanne, France
| | - Kexin Yan
- Ansys France, Villeurbanne, France
- LaMCoS, Laboratoire de Mécanique des Contacts et des Structures, CNRS UMR5259, INSA Lyon, University of Lyon, Villeurbanne, France
| | | | - Aline Bel-Brunon
- LaMCoS, Laboratoire de Mécanique des Contacts et des Structures, CNRS UMR5259, INSA Lyon, University of Lyon, Villeurbanne, France
| | - Jean Porterie
- Cardiac Surgery Department, Rangueil University Hospital, Toulouse, France
| | - Siyu Lin
- IMVIA Laboratory, University of Burgundy, Dijon, France
- Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Diana Marcela Marin-Castrillon
- IMVIA Laboratory, University of Burgundy, Dijon, France
- Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Alain Lalande
- IMVIA Laboratory, University of Burgundy, Dijon, France
- Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Olivier Bouchot
- Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, Dijon, France
| | - Morgan Daniel
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Pierre Escrig
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Jacques Tomasi
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Pier Paolo Valentini
- Department of Enterprise Engineering “Mario Lucertini”, University of Rome Tor Vergata, Rome, Italy
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Zhu W, Wang Y, Chen Y, Liu J, Zhou C, Shi Q, Huang S, Yang C, Li T, Xiong B. Dynamic Changes in the Aorta During the Cardiac Cycle Analyzed by ECG-Gated Computed Tomography. Front Cardiovasc Med 2022; 9:793722. [PMID: 35665265 PMCID: PMC9160308 DOI: 10.3389/fcvm.2022.793722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/19/2022] [Indexed: 11/28/2022] Open
Abstract
Background To characterize the difference in aortic dimensions during the cardiac cycle with electrocardiogram (ECG)-gated computed tomography angiography (CTA) and to determine whether other parameters in comparison to diameter could potentially provide a more accurate size reference for stent selection at the aortic arch and the proximal thoracic descending aorta. Methods The CTA imaging of 90 patients during the cardiac cycle was reviewed. Three anatomic locations were selected for analysis (level A: 1 cm proximal to the innominate artery; level B: 1 cm distal to the left common carotid artery; and level C: 1 cm distal to the left subclavian artery). We measured the maximum diameter, the minimum diameter, the lumen area, the lumen perimeter, and the diameter derived from the lumen area, and the changes of each parameter at each level during the cardiac cycle were compared. Results The mean age was 60.9 ± 12.4 years (range, 16–78 years). There was a significant difference in the aortic dimensions during the cardiac cycle (p < 0.001). The diameter derived from the lumen area at all three levels was changed least over time when compared to the area, perimeter, and the maximum aortic diameter (all p < 0.01). Conclusion The aortic dimensional differences during the cardiac cycle are significant. The aortic diameter derived from the lumen area over other parameters may provide a better evaluation for selecting the size of the stent at the aortic arch and the proximal thoracic descending aorta. A prospective study comparing these different measurement parameters regarding the outcomes is still needed to evaluate the clinical implications.
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Affiliation(s)
- Wenying Zhu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yingliang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yang Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jiacheng Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chen Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qin Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Songjiang Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chongtu Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Tongqiang Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
- *Correspondence: Bin Xiong
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Li X, Zhu L, Zhang L, Song C, Zhang H, Xia S, Guo W, Jing Z, Lu Q. Anatomical Feasibility Study on Novel Ascending Aortic Endograft With More Proximal Landing Zone for Treatment of Type A Aortic Dissection. Front Cardiovasc Med 2022; 9:843551. [PMID: 35463748 PMCID: PMC9019117 DOI: 10.3389/fcvm.2022.843551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Type A aortic dissection (TAAD) is associated with high morbidity and mortality, and open surgery is the best treatment option. Development of endovascular repair devices for TAAD will benefit patients deemed unfit for open surgery. In this study, we performed a thorough investigation of anatomical features in Asian patients with TAAD to learn about the patient eligibility of a novel ascending aortic endograft technique. Methods Computed tomography angiography (CTA) images of TAAD cases in our institution from January 2015 to November 2021 were reviewed, and three-dimensional reconstructions were performed with the Endosize software (Therenva, Rennes, France). Anatomic structures including length measured along centerline and greater/lesser curvature, ascending aorta/aortic root dimensions, as well as location of entry tear and extent of dissection were analyzed. Results A total of 158 patients were included [median age 58 years, interquartile range (IQR), 30–76 years; 115 males, 72.8%]. In 99 (62.7%) of the cases, entry tear was distal to the sinotubular junction (STJ). In 106 (67.1%) of the cases, the pathology proximally extended into the aortic root, which was intramural hematoma in 37 (23.4%) of the cases, and the aortic root was free from the pathology in 52 (32.9%) of the cases. The median distance from the STJ to the proximal edge of the ostium of the innominate artery (IA) measured along the centerline was 65 mm (IQR 58–74 mm). The median distance from the distal edge of the higher coronary ostium to the STJ was 7.95 mm (IQR 5.625–10.9 mm). The bare metal stent part was set between the edge of the higher coronary ostium and the STJ. In our series, 63 (39.9%) of the cases had this distance >10 mm. The relative difference was <20% between the STJ and the proximal edge of the ostium of the IA in 92 (58.2%) of the cases. Ascending aorta radius of curvature was 52.2 mm (IQR 43.7–63.7 mm). Conclusions Our study demonstrates that 56.3% of the TAAD cases would be amenable to endovascular repair by the novel ascending aortic endograft, with sufficient landing zone free of the dissected aorta.
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Saushkin VV, Panfilov DS, Vrublevsky AV, Sazonova SI, Kozlov BN. [Role of imaging modalities in the choice of treatment strategy for mega aorta syndrome]. Khirurgiia (Mosk) 2022:67-74. [PMID: 35147003 DOI: 10.17116/hirurgia202202167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The authors report a 76-year-old female with mega-aorta syndrome that was asymptomatic for a long time. The first symptoms appeared after ascending aorta enlargement up to 81 mm and compression of superior vena cava. The patient underwent frozen elephant trunk procedure. The authors demonstrate the possibilities of assessing the aortic strain by ECG-synchronized CT angiography and 2D transesophageal ultrasound with speckle tracking. Potential role of these methods in determining the type of aortic reconstruction is discussed.
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Affiliation(s)
- V V Saushkin
- Tomsk National Research Medical Center, Tomsk, Russia
| | - D S Panfilov
- Tomsk National Research Medical Center, Tomsk, Russia
| | | | - S I Sazonova
- Tomsk National Research Medical Center, Tomsk, Russia
| | - B N Kozlov
- Tomsk National Research Medical Center, Tomsk, Russia
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Ko JP, Goldstein JM, Latson LA, Azour L, Gozansky EK, Moore W, Patel S, Hutchinson B. Chest CT Angiography for Acute Aortic Pathologic Conditions: Pearls and Pitfalls. Radiographics 2021; 41:399-424. [PMID: 33646903 DOI: 10.1148/rg.2021200055] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chest CT angiography (CTA) is essential in the diagnosis of acute aortic syndromes. Chest CTA quality can be optimized with attention to technical parameters pertaining to noncontrast imaging, timing of contrast-enhanced imaging, contrast material volume, kilovolt potential, tube-current modulation, and decisions regarding electrocardiographic-gating and ultra-fast imaging, which may affect the accurate diagnosis of acute aortic syndromes. An understanding of methods to apply to address suboptimal image quality is useful, as the accurate identification of acute aortic syndromes is essential for appropriate patient management. Acute aortic syndromes have high morbidity and mortality, particularly when involving the ascending aorta, and include classic aortic dissection, penetrating atherosclerotic ulcer, and acute intramural hematoma. An understanding of the pathogenesis and distinguishing imaging features of acute aortic syndromes and aortic rupture and some less common manifestations is helpful when interpreting imaging examinations. Related entities, such as ulcerated plaque, ulcerlike projections, and intramural blood pools, and mimics, such as vasculitis and aortic thrombus, are important to recognize; knowledge of these is important to avoid interpretive pitfalls. In addition, an awareness of postsurgical aortic changes can be useful when interpreting CTA examinations when patient history is incomplete. The authors review technical considerations when performing CTA, discuss acute aortic syndromes, and highlight diagnostic challenges encountered when interpreting aortic CTA examinations. ©RSNA, 2021.
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Affiliation(s)
- Jane P Ko
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Jonathan M Goldstein
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Larry A Latson
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Lea Azour
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Elliott K Gozansky
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - William Moore
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Smita Patel
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
| | - Barry Hutchinson
- From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.)
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Belvroy VM, Zubair MM, van Herwaarden JA, Trimarchi S, Moll FL, Bismuth J. Important longitudinal and circumferential pulsatile changes in zone 0 of the aorta during the cardiac cycle. Eur J Cardiothorac Surg 2020; 59:ezaa306. [PMID: 33001164 DOI: 10.1093/ejcts/ezaa306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/12/2020] [Accepted: 07/18/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Correct stent-graft sizing is important when planning for thoracic endovascular repair in zone 0. As the movements of the aorta are constantly evolving in longitudinal and circumferential directions during the cardiac cycle, the diameter may not be the only important measurement. The aim of this study is to measure the circumferential and longitudinal pulsatile changes throughout the cardiac cycle. METHODS Ninety-two patients, who were evaluated for transcatheter aortic valve replacement, were selected for this retrospective study. Their electrocardiogram-gated cardiac computed tomography was analysed. We identified the area, perimeter and diameter of the thoracic aorta in zone 0 and calculated the differences between these parameters at 3 locations in zone 0. The measurements were made in multiplanar views perpendicular to the semi-automatically created centreline in both systolic and diastolic phases. RESULTS The mean age of our study cohort was 77 ± 11 years. The mean change between systole and diastole of the area (mm2), perimeter (mm) and diameter (mm) were compared at 3 different locations in the ascending aorta: at the sinotubular junction (0.78 mm2 vs 0.89 mm vs 1.41 mm), mid-ascending (0.72 mm2 vs 0.68 vs 0.81 mm) and proximal edge of the brachiocephalic artery (0.76 mm2 vs 0.73 mm vs 0.73 mm). The change in percentage is the smallest in the area at the sinotubular junction compared to the perimeter and diameter (2.6% vs 3.1% vs 4.7%). CONCLUSIONS Changes in measurement of ascending aortic diameter with cardiac cycle are larger than measurement change in the area. This is especially more pronounced in zone 0A. For more accurate information on the morphometric changes, it may be necessary to measure the area when planning for thoracic endovascular repair to maximize results. A prospective study comparing these different measurements regarding the outcomes is advised by the authors to understand the clinical implications.
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Affiliation(s)
- Viony M Belvroy
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - M Mujeeb Zubair
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | - Santi Trimarchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jean Bismuth
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
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